Policy and Community Hospitals Workshop

1
Policy and Community Hospitals Workshop

• Louise Molina
• Practice Based Commissioning Implementation
  Manager
• Chiltern South Bucks PCT

2
Aim of Workshop

• To ensure that delegates have an understanding
  of how PBR, PBC, Choice and Contestability should
  effectively be employed to influence and support
  the development of Community Hospitals.

3
Using the Websitewww.developingcommunityhospital
s.org.uk

• Many of the principles that are outlined on the
  website can also be applied to PBR, PBC, Choice
  and Contestability, so the website is not just
  useful for commissioners of community hospitals,
  but to all commissioning bodies.
• For instance, the checklists may be particularly
  useful to apply to the commissioning process to
  ensure that all key responsibilities have been
  met.

4
Shared Objectives of PBR and PBC

• Choice meeting patients expectations
• Cost Efficiency
• Accessibility
• Money following patients
• Demand management
• Motivation to improve quality through service
  redesign

5
Conflict of Interest between PBR and PBC?

• PBC requires the adoption of an Invest to Save
  principle in order to meet its objectives. This
  is achieved by expanding the services offered in
  Primary Care, including community hospitals. For
  example, GPwSIs and Specialist Nurses running
  clinics, diagnostic provision, expanding
  intermediate care. This means taking activity
  away from the Acute Trusts, who will be paid by
  the results of what they deliver. PBC can
  therefore reduce the Acute Trusts opportunities
  to generate income. This could threaten some
  specialities.

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How does contestability affect providers?

• All providers, which includes community
  hospitals, GPs, Acute Trusts and independent
  providers, will be in direct competition with
  each other to attract patients
• Greater security/opportunity for current
  providers with proven results
• Providers will have to know how to market their
  services effectively does the independent
  sector have a head start here?
• Potential income dilution as the DH have been
  clear that policy changes are not intended to
  increase the overall amount of cash in the
  system, but redistribute it
• Conflict of interest? GPs as providers and
  commissioners
• Providers will have to compete with each other on
  cost and quality.

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How does contestability affect commissioners(1)?

• Commissioners will have to apply a whole range
  of principles when choosing providers and
  negotiating contracts. These principles include
• Access
• Choice
• Governance, including meeting NSLA quality
  standards
• Cost efficiency and Value for Money

• Risk sharing
• Performance monitoring, including clinical audit
• Evidence using data to establish demand for eg
  activity spells/public health reports, LDPs
• Innovation in practice
• Care pathways
• Demand management

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How does contestability affect commissioners(2)?

• Greater influence over cost and quality
• Existing relationships with providers could be
  effected as more potential providers come forward
• Potentially new partnerships with the independent
  sector
• Confusion over existing loyalties? What happens
  if two equitable providers tender to provide the
  same service, if one provider is already known?
  Uncomfortable decisions may have to be made.

9
Rewards of Policy Change

• The rewards will come from how we manage the
  relationships between provider/ provider and
  providers /commissioners.
• So, how can positive relationships best be
  achieved

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Recommendations for Implementing Policy Change(1)

• Adopt a fair and transparent process with each
  other and the general public.
• Providers need to be willing to share
  information, above and beyond statutory
  requirements
• Providers need to be open to jointly providing
  services, for eg GP practices, GPs and Community
  Hospitals, Acute and Community Hospitals, NHS and
  Non-NHS
• Be open minded to innovation and change only
  dead fish go with the flow!

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Recommendations for Implementing Policy Change(2)

• Establish key responsibilities. For instance, the
  Acute Trust and Community Hospitals should be
  responsible for providing accurate information on
  activity and quality and the PCTs should be
  responsible for ensuring that referrals are
  appropriate and detailed clinically, in
  conjunction with GPs.
• Work together to identify and manage risks
• Establish joint governance arrangements, with
  patients as the main focus as they are the people
  we are ultimately accountable to.

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Opportunities for Community Hospitals

• Community hospitals have the opportunity to
  develop services with all sectors Acute Trusts,
  GPs, Independent Sector and the Voluntary Sector
• They are well placed to meet all of the shared
  objectives of PBR and PBC as they offer an
  alternative choice to patients and commissioners,
  and are uniquely placed in the communities where
  people live
• They have the scope to reduce waiting lists by
  offering alternative operating and diagnostic
  facilities
• They will assist commissioners in managing demand
• By working closely with partners to achieve the
  above, they will provide value for money and
  become pivotal to the success of policy change.

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Final Comment

• Recent policy changes will undoubtedly lead to
  new opportunities, challenges and risks.
• It is said that a life without risk is a life
  half lived so lets take the opportunity to
  breathe new life in to the NHS..

14
Discussion (1)
15
Discussion (2)